Successes - ACC Claim Management

Our ManageACC division has been busy.

Sue and her team proactively look after our clients ACC needs. This covers a range of services ranging from health monitoring; pre-employment testing; psychological assessments including covering neurodiversity; drug testing; physio and other allied health bookings; doctor and specialist appointments; and of course, direct case management.

Below are five successes in the claim management space that will resonate with a lot of our readers. I know our clients do!

Health Condition

Employee scratched their hand at work. The injury became infected and triggered a pre-existing health condition. Significant time off was awarded via ACC weekly compensation.

Disputed by Manage – claim overturned in favour of non work.

Health conditions under Experience Rating, cannot be taken into account in determining the time-off. ACC works on a causation basis - there has to be a cause for the injury. ACC covers accident only so health cannot impact the outcome.

We note that the worker in this case still has access to all ACC entitlements and the employer did not seek to get the first week payment at 80% reversed. Although it could have given this was no longer a workplace claim.

Surgery Declined

ACC declined surgery as ACC could not confirm the injury was caused by the incident. This left the worker in a compromised position which was not ideal.

Disputed by Manage and evidence was provided that the injury was being caused by gradual process. The outcome is that surgery was approved and full cost of claim moved away from current employer.

Gradual process claims can be allocated to past employers either in full or part. Gradual process is covered under a work claim but not outside of work.

We note that the worker still had full cover and all entitlements. Again, the employer did not seek to have the first week payment at 80% refunded which we think is the right thing to do.

Non-Work

Employee claimed a workplace injury – didn’t declare the injury until a month after the fact.

Disputed by Manage and evidence provided to ACC showed the employee was not at work on the day of the injury. All claim and associated costs removed.

In this case the worker was not being honest about their claim. This technically means that the first week payment made by the employer, is fraudulently claimed and is therefore theft. We let the employer determine the right path in line with the framework set out in the individual employment agreement.

Contractors

Employees appeared on a company’s ACC claim report that were actually contractors.

This was disputed by Manage as these workers were not employees of the company. ACC removed all 3 claims and attributed to correct employer.

The three employees still have access to their ACC entitlements including weekly compensation. The impact though, no longer impacts this business.

This scenario is quite common especially with labour hire workers.

Deemed Decision

The employer challenged ACC on a claim via email. ACC did not act on this email in the right way or within the prescribed 90 day period as set out in the legislation. ACC failed to escalate the challenge via the correct channels. In fact, ACC did not escalate anything at all.

Manage challenged ACC on failing to adhere to its own legislation and by doing so, must remove the claim in question and all associated costs from the employer’s profile. The reviewer (mediator) agreed and determined a ‘deemed decision’ in our favour.

In this case, there was nil impact on the worker as we challenged a technicality in law.

This scenario is more common than people realise. The ACC legislation allows for multiple ‘technicalities’ where claims can be removed from the employer’s profile and without impacting the employee.

For the above scenarios, Manage was able to claim costs from ACC which reduces the financial impact on the employer (client). This does make challenging claims more feasible.

Well done to Sue and her team. These are great examples of where we look after both the employer and the employee albeit with one exception - where the employee has lied.

ACC Claim Management, it’s what we do.

Marty WoutersSeptember 9, 2023

Blog

Successes - ACC Claim Management

Our ManageACC division has been busy.

Below are five successes in the claim management space that will resonate with a lot of our readers. I know our clients do!

Health Condition

Employee scratched their hand at work. The injury became infected and triggered a pre-existing health condition. Significant time off was awarded via ACC weekly compensation.

Disputed by Manage – claim overturned in favour of non work.

Health conditions under Experience Rating, cannot be taken into account in determining the time-off. ACC works on a causation basis - there has to be a cause for the injury. ACC covers accident only so health cannot impact the outcome.

We note that the worker in this case still has access to all ACC entitlements and the employer did not seek to get the first week payment at 80% reversed. Although it could have given this was no longer a workplace claim.

Surgery Declined

ACC declined surgery as ACC could not confirm the injury was caused by the incident. This left the worker in a compromised position which was not ideal.

Disputed by Manage and evidence was provided that the injury was being caused by gradual process. The outcome is that surgery was approved and full cost of claim moved away from current employer.

Gradual process claims can be allocated to past employers either in full or part. Gradual process is covered under a work claim but not outside of work.

We note that the worker still had full cover and all entitlements. Again, the employer did not seek to have the first week payment at 80% refunded which we think is the right thing to do.

Non-Work

Employee claimed a workplace injury – didn’t declare the injury until a month after the fact.

Disputed by Manage and evidence provided to ACC showed the employee was not at work on the day of the injury. All claim and associated costs removed.

Contractors

Employees appeared on a company’s ACC claim report that were actually contractors.

This was disputed by Manage as these workers were not employees of the company. ACC removed all 3 claims and attributed to correct employer.

The three employees still have access to their ACC entitlements including weekly compensation. The impact though, no longer impacts this business.

This scenario is quite common especially with labour hire workers.

Deemed Decision

The employer challenged ACC on a claim via email. ACC did not act on this email in the right way or within the prescribed 90 day period as set out in the legislation. ACC failed to escalate the challenge via the correct channels. In fact, ACC did not escalate anything at all.

Manage challenged ACC on failing to adhere to its own legislation and by doing so, must remove the claim in question and all associated costs from the employer’s profile. The reviewer (mediator) agreed and determined a ‘deemed decision’ in our favour.

In this case, there was nil impact on the worker as we challenged a technicality in law.

This scenario is more common than people realise. The ACC legislation allows for multiple ‘technicalities’ where claims can be removed from the employer’s profile and without impacting the employee.

For the above scenarios, Manage was able to claim costs from ACC which reduces the financial impact on the employer (client). This does make challenging claims more feasible.

Well done to Sue and her team. These are great examples of where we look after both the employer and the employee albeit with one exception - where the employee has lied.

ACC Claim Management, it’s what we do.